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Rong C, Zhu S, Zhang Q, Xu H, Zhang L, Han Q. Minimally Invasive Percutaneous Screw Guided by 3-Dimensional-Printed Guide for the Treatment of Scaphoid Fractures. J Hand Surg Am 2023; 48:1279.e1-1279.e7. [PMID: 36333242 DOI: 10.1016/j.jhsa.2022.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/10/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE This study aimed to explore the feasibility and efficacy of percutaneous fixation of minimally displaced scaphoid waist fractures using a 3-dimensional-printed guide in 10 cases. METHODS Fractures were examined using preoperative computed tomography. The skin interface and bone models were reconstructed using computed tomography data. Guidewire insertion was assisted by a guide. Computed tomography was performed 4-6 weeks after surgery until healing of the fracture was confirmed. The mean follow-up period was 7 months (range, 6-9 months). The fracture healing time, grip strength, flexion-extension arc, patient-rated wrist evaluation, and Mayo wrist score were recorded. RESULTS A total of 6 hands were in the dominant limb. The mean operation time was 41 minutes (range, 32-70 minutes). Three (30%) scaphoids healed at 6 weeks after surgery, 8 (80%) scaphoids healed at 8 weeks after surgery, and 100% scaphoids healed at 12 weeks after surgery. After correcting for hand dominance, the mean grip strength was 84% (range, 71% to 95%) of that of the contralateral side. The flexion-extension arc was 97% (range, 82% to 100%) of that of the contralateral side. The mean Mayo wrist score was 95 (range, 85-100), and pain decreased to minimal levels. All patients returned to their preinjury activities. CONCLUSIONS Three-dimensional printing is an effective and feasible technology that can help guide intraoperative processes. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Cunmin Rong
- Department of Hand & Foot Surgery, Affiliated Hospital of Jining Medical University, People's Republic of China.
| | - Shaobo Zhu
- Department of Hand & Foot Surgery, Affiliated Hospital of Jining Medical University, People's Republic of China
| | - Qinglin Zhang
- Department of Hand & Foot Surgery, Affiliated Hospital of Jining Medical University, People's Republic of China
| | - Hui Xu
- Department of Hand & Foot Surgery, Affiliated Hospital of Jining Medical University, People's Republic of China
| | - Liangliang Zhang
- Department of Hand & Foot Surgery, Affiliated Hospital of Jining Medical University, People's Republic of China
| | - Qingluan Han
- Department of Hand & Foot Surgery, Affiliated Hospital of Jining Medical University, People's Republic of China
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Stübig T, Windhagen H, Krettek C, Ettinger M. Computer-Assisted Orthopedic and Trauma Surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:793-800. [PMID: 33549155 PMCID: PMC7947640 DOI: 10.3238/arztebl.2020.0793] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/06/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are many ways in which computer-assisted orthopedic and trauma surgery (CAOS) procedures can help surgeons to plan and execute an intervention. METHODS This study is based on data derived from a selective search of the literature in the PubMed database, supported by a Google Scholar search. RESULTS For most applications the evidence is weak. In no sector did the use of computer-assisted surgery yield any relevant clinical or functional improvement. In trauma surgery, 3D-navigated sacroiliac screw fixation has become clinically established for the treatment of pelvic fractures. One randomized controlled trial showed a reduction in the rate of screw misplacement: 0% with 3D navigation versus 20.4% with the conventional procedure und 16.6% with 2D navigation. Moreover, navigation-assisted pedicle screw stabilization lowers the misplacement rate. In joint replacements, the long-term results showed no difference in respect of clinical/functional scores, the time for which the implant remained in place, or aseptic loosening. CONCLUSION Computer-assisted procedures can improve the precision of certain surgical interventions. Particularly in joint replacement and spinal surgery, the research is moving away from navigation in the direction of robotic procedures. Future studies should place greater emphasis on clinical and functional results.
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Affiliation(s)
- Timo Stübig
- Department of Traumatology, Hannover Medical School
| | - Henning Windhagen
- Department of Orthopedic Surgery, Hannover Medical School, Annastift
| | | | - Max Ettinger
- Department of Orthopedic Surgery, Hannover Medical School, Annastift
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Xiao ZR, Xiong G. Computer-assisted Surgery for Scaphoid Fracture. Curr Med Sci 2018; 38:941-948. [PMID: 30536054 DOI: 10.1007/s11596-018-1968-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/11/2018] [Indexed: 01/09/2023]
Abstract
The computer-assisted surgery (CAS) has significantly improved the accuracy, reliability and outcomes of traumatic, spinal, nerve surgery and many other operations with a less invasive way. The application of CAS for scaphoid fractures remains experimental. The related studies are scanty and most of them are cadaver researches. Some intrinsic defects from the registration procedure, scan and immobilization of limbs may inevitably result in deviations. Some deviations become more obvious with operations of small bones (such as scaphoid) although they are acceptable for spine and other orthopedic surgeries. We reviewed the current literatures on the applications of CAS for scaphoid operation and summarized technical principles, scan and registration methods, immobilization of limbs and their outcomes. On the basis of the data, we analyzed the limitations of this technique and envisioned its future development.
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Affiliation(s)
- Zi-Run Xiao
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China.,Department of Orthopaedic Surgery, the 91st Central Hospital of Chinese People's Liberation Army, Henan, 454000, China
| | - Ge Xiong
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China.
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Ten Berg PWL, Dobbe JGG, Brinkhorst ME, Meermans G, Strackee SD, Verstreken F, Streekstra GJ. Scaphoid screw fixation perpendicular to the fracture plane: Comparing volar and dorsal approaches. Orthop Traumatol Surg Res 2018; 104:109-113. [PMID: 29253617 DOI: 10.1016/j.otsr.2017.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 11/02/2017] [Accepted: 11/08/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION To percutaneously fixate a midwaist scaphoid fracture, both volar and dorsal approaches are considered valid options although they may have different screw insertion angles relative to the scaphoid fracture plane influencing fixation stability. In this virtual simulation study, we investigated the accessibility of placing a screw perpendicularly to the fracture plane in transverse and horizontal oblique scaphoid midwaist fracture models and compared standard volar and dorsal approaches. MATERIAL AND METHODS Computed tomography scans of 38 healthy wrists were used to obtain virtual 3-dimensional wrist models in flexion and extension. In case the trapezium in volar approach or the distal radius in dorsal approach obstructed the screw axis perpendicular to the fracture plane, an alternative non-obstructed screw axis was chosen as close as possible to the perpendicular axis. The deviation angle between the best possible non-obstructed screw placement and true perpendicular screw placement was quantified. RESULTS For transverse fractures, the average deviation angle (±standard deviation) was 8° (±5°) in volar approach, and 0° (±0°) in dorsal approach. For horizontal oblique fractures, these angles were 40° (±6°) and 14° (±8°), respectively. DISCUSSION In our simulations, compared to the volar approach, the dorsal approach provided the most precise screw placement perpendicular to the fracture plane, with the largest differences for horizontal oblique fractures. When taken in addition to screw purchase, thread engagement and protrusion risk, information about screw orientation may help surgeons in deciding between percutaneous approaches in scaphoid surgery on which there is currently no consensus. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- P W L Ten Berg
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - M E Brinkhorst
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - G Meermans
- Department of Orthopaedics, Lievensberg Hospital, 4624 VT Bergen Op Zoom, The Netherlands
| | - S D Strackee
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - F Verstreken
- Department of Orthopaedics, Monica Hospital, 2018 Antwerp, Belgium
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Anas EMA, Seitel A, Rasoulian A, John PS, Ungi T, Lasso A, Darras K, Wilson D, Lessoway VA, Fichtinger G, Zec M, Pichora D, Mousavi P, Rohling R, Abolmaesumi P. Registration of a statistical model to intraoperative ultrasound for scaphoid screw fixation. Int J Comput Assist Radiol Surg 2016; 11:957-65. [PMID: 26984552 DOI: 10.1007/s11548-016-1370-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/26/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Volar percutaneous scaphoid fracture fixation is conventionally performed under fluoroscopy-based guidance, where surgeons need to mentally determine a trajectory for the insertion of the screw and its depth based on a series of 2D projection images. In addition to challenges associated with mapping 2D information to a 3D space, the process involves exposure to ionizing radiation. Three-dimensional ultrasound has been suggested as an alternative imaging tool for this procedure; however, it has not yet been integrated into clinical routine since ultrasound only provides a limited view of the scaphoid and its surrounding anatomy. METHODS We propose a registration of a statistical wrist shape + scale + pose model to a preoperative CT and intraoperative ultrasound to derive a patient-specific 3D model for guiding scaphoid fracture fixation. The registered model is then used to determine clinically important intervention parameters, including the screw length and the trajectory of screw insertion in the scaphoid bone. RESULTS Feasibility experiments are performed using 13 cadaver wrists. In 10 out of 13 cases, the trajectory of screw suggested by the registered model meets all clinically important intervention parameters. Overall, an average 94 % of maximum allowable screw length is obtained based on the measurements from gold standard CT. Also, we obtained an average 92 % successful volar accessibility, which indicates that the trajectory is not obstructed by the surrounding trapezium bone. CONCLUSIONS These promising results indicate that determining clinically important screw insertion parameters for scaphoid fracture fixation is feasible using 3D ultrasound imaging. This suggests the potential of this technology in replacing fluoroscopic guidance for this procedure in future applications.
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Affiliation(s)
- Emran Mohammad Abu Anas
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada.
| | - Alexander Seitel
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Abtin Rasoulian
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | | | - Tamas Ungi
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Andras Lasso
- School of Computing, Queen's University, Kingston, ON, Canada
| | | | - David Wilson
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada.,Department of Orthopaedics and Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Parvin Mousavi
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Robert Rohling
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada.,Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Purang Abolmaesumi
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
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Belkova A, Pichora DR, Ellis RE. Calibration of mobile-gantry computed tomography for surgical navigation. Int J Comput Assist Radiol Surg 2015; 11:521-7. [PMID: 26450109 DOI: 10.1007/s11548-015-1302-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 09/14/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Image-guided interventions that use preoperative 3D computed tomography (CT) models are limited by the preoperative segmentation time 3D image and collection of intraoperative registration data. Intraoperative CT imaging can be ergonomically efficient in a direct navigation system if the imaging device is accurately calibrated. A mobile-gantry CT scanner offers improved patient safety but presents technical challenges beyond those of a conventional scanner. The goal was to calibrate an optoelectronic navigation system to mobile-gantry CT with millimeter-level accuracy. METHODS A custom calibration device was designed and manufactured. The calibrator contained optoelectronic markers for navigation reference and radio-opaque markers for CT reference. Calibrations were performed with a ceiling-mounted optoelectronic camera and with a portable camera, and then verified for accuracy. RESULTS The component fiducial registration errors were extremely small, being 0.36 mm, with standard deviation of 0.16 mm, for the ceiling-mounted camera, and 0.05 mm, with standard deviation of 0.01 mm, for the portable camera. The net target registration error, measured as RMS deviation, was 1.58 mm for the ceiling-mounted camera and 0.73 mm for the portable camera. CONCLUSIONS High-accuracy calibration of the mobile-gantry CT scanner was possible from a single preoperative CT image. A ceiling-mounted optoelectronic camera, which is ergonomically preferable, marginally met the accuracy criteria. The portable camera, which is in widespread use for conventional navigated surgery, had deep sub-millimeter error. This study demonstrates that high accuracy is achievable and offers a system developer options to trade off accuracy and user convenience in direct surgical navigation.
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Affiliation(s)
- Anna Belkova
- School of Computing, Queen's University, Kingston, K7L 3N6, Canada
| | - David R Pichora
- Department of Surgery, Queen's University, Kingston, K7L 3N6, Canada
| | - Randy E Ellis
- School of Computing, Queen's University, Kingston, K7L 3N6, Canada. .,Department of Surgery, Queen's University, Kingston, K7L 3N6, Canada.
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Abu Anas EM, Seitel A, Rasoulian A, St John P, Pichora D, Darras K, Wilson D, Lessoway VA, Hacihaliloglu I, Mousavi P, Rohling R, Abolmaesumi P. Bone enhancement in ultrasound using local spectrum variations for guiding percutaneous scaphoid fracture fixation procedures. Int J Comput Assist Radiol Surg 2015; 10:959-69. [PMID: 25847667 DOI: 10.1007/s11548-015-1181-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/17/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE The scaphoid bone is the most frequently fractured bone in the wrist. When fracture fixation is indicated, a screw is inserted into the bone either in an open surgical procedure or percutaneously under fluoroscopic guidance. Due to the complex geometry of the wrist, fracture fixation is a challenging task. Fluoroscopic guidance exposes both the patient and the physician to ionizing radiation. Ultrasound-based guidance has been suggested as a real-time, radiation-free alternative. The main challenge of using ultrasound is the difficulty in interpreting the images due to the low contrast and noisy nature of the data. METHODS We propose a bone enhancement method that exploits local spectrum features of the ultrasound image. These features are utilized to design a set of quadrature band-pass filters and subsequently estimate the local phase symmetry, where high symmetry is expected at the bone locations. We incorporate the shadow information below the bone surfaces to further enhance the bone responses. The extracted bone surfaces are then used to register a statistical wrist model to ultrasound volumes, allowing the localization and interpretation of the scaphoid bone in the volumes. RESULTS Feasibility experiments were performed using phantom and in vivo data. For phantoms, we obtain a surface distance error 1.08 mm and an angular deviation from the main axis of the scaphoid bone smaller than 5°, which are better compared to previously presented approaches. CONCLUSION The results are promising for further development of a surgical guidance system to enable accurate anatomy localization for guiding percutaneous scaphoid fracture fixations.
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Abstract
Background The treatment for undisplaced scaphoid waist fractures has evolved from conventional cast immobilization to percutaneous screw insertion. Percutaneous fixation reduces some of the risks of open surgery, but can be technically demanding and carries the risk of radiation exposure. Recently, computer-assisted percutaneous scaphoid fixation (CAPSF) has been gaining interest. Materials and Methods Conventional percutaneous scaphoid fixation is performed under fluoroscopic guidance and involves insertion of a guide wire along the length of the scaphoid to facilitate placement of a cannulated screw. Adapting computer-assisted techniques for scaphoid fixation poses several unique challenges including patient tracking and registration. Results To date, five groups have successfully implemented systems for CAPSF. These systems have implemented wrist immobilization strategies to resolve the issue of patient tracking and have developed unique guidance techniques incorporating 2D fluoroscope, cone-beam CT, and ultrasound, to circumvent patient-based registration. Conclusions Computer-aided percutaneous pinning of scaphoid waist fractures can significantly reduce radiation exposure and has the potential to improve the accuracy of this procedure. This article reviews the rationale for, and the evolution of, CAPSF and describes the key principles of computer-assisted technology.
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Affiliation(s)
- Erin J. Smith
- Department of Mechanical Engineering, Queen's University, Kingston, Ontario, Canada
| | - Randy E. Ellis
- Department of Mechanical Engineering, Queen's University, Kingston, Ontario, Canada
- School of Computing, Queen's University, Kingston, Ontario, Canada
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - David R. Pichora
- Department of Mechanical Engineering, Queen's University, Kingston, Ontario, Canada
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
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Investigating the performance of a wrist stabilization device for image-guided percutaneous scaphoid fixation. Int J Comput Assist Radiol Surg 2013; 9:155-64. [PMID: 23588508 DOI: 10.1007/s11548-013-0834-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 03/11/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Conventional navigated surgery relies on placement of a reference marker on the anatomy of interest. However, placement of such a marker is not readily feasible in small anatomic regions such as the scaphoid bone of the wrist. This study aimed to develop an alternative mechanism for patient tracking that could be used to perform navigated percutaneous scaphoid fixation. METHODS A prototype wrist stabilization device was developed to immobilize the scaphoid relative to a reference marker attached to the device. A position measurement system and 3D fluoroscopy were used to study the accuracy and limitations of wrist stabilization during simulated clinical usage with a cadaver specimen. Reference markers mounted on the device were used to measure intra-device motion. Radiometallic beads implanted in the scaphoid were used to measure patient-device motion. Navigated planning and guidance of scaphoid fixation were performed in five cadaver and eight "ideally immobilized" plastic specimens. Postoperative 3D fluoroscopy was used to assess the accuracy of navigated drilling. RESULTS The average intra-device motion was 1.9 mm during load application, which was elastically recovered upon release of the load. Scaphoid motion relative to the reference marker was predominately rotational with an average displacement of 1.25 mm and 2.0°. There was no significant difference in the accuracy of navigated drilling between the cadaver specimens and the ideally immobilized group. CONCLUSIONS The prototype wrist stabilization device meets the criteria for effective wrist stabilization. This study provides insight concerning proper use of the device to minimize scaphoid displacement and design recommendations to improve immobilization.
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Smith EJ, Anstey JA, Venne G, Ellis RE. Using additive manufacturing in accuracy evaluation of reconstructions from computed tomography. Proc Inst Mech Eng H 2013; 227:551-9. [DOI: 10.1177/0954411912474612] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bone models derived from patient imaging and fabricated using additive manufacturing technology have many potential uses including surgical planning, training, and research. This study evaluated the accuracy of bone surface reconstruction of two diarthrodial joints, the hip and shoulder, from computed tomography. Image segmentation of the tomographic series was used to develop a three-dimensional virtual model, which was fabricated using fused deposition modelling. Laser scanning was used to compare cadaver bones, printed models, and intermediate segmentations. The overall bone reconstruction process had a reproducibility of 0.3 ± 0.4 mm. Production of the model had an accuracy of 0.1 ± 0.1 mm, while the segmentation had an accuracy of 0.3 ± 0.4 mm, indicating that segmentation accuracy was the key factor in reconstruction. Generally, the shape of the articular surfaces was reproduced accurately, with poorer accuracy near the periphery of the articular surfaces, particularly in regions with periosteum covering and where osteophytes were apparent.
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Affiliation(s)
- Erin J Smith
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
| | - Joseph A Anstey
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Gabriel Venne
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Randy E Ellis
- School of Computing, Queen’s University, Kingston, ON, Canada
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Schöll H, Mentzel M, Jones A, Gülke J, Gebhard F, Kraus M. Image guidance can support scaphoid K-wire insertion: an experimental study and initial clinical experience. Int J Comput Assist Radiol Surg 2012. [PMID: 23196791 DOI: 10.1007/s11548-012-0799-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE In the treatment of small bone fractures, such as the scaphoid bone, conventional navigation is limited by its dependence on fixed reference arrays. We introduce a new technique based on reference markers in surgical instruments. If visible on a standard fluoroscopic image, static trajectories are overlaid in this image to guide implant insertions. Fixed markers are not required. The purpose of this study was to identify the possible advantages of the new guidance technique. METHODS For this study, 20 artificial hand specimens were randomized into two groups and blinded with polyurethane foam: 10 were treated conventionally and 10 were image guided. We used a clip containing radiopaque markers, which was detected by the system's workstation. A static trajectory was displayed consecutively in the fluoroscopic image to serve as an aiming device. Secondly, we included 3 patients with fractures of the scaphoid bone to test the integrability of this novel method in a clinical setting. RESULTS In the experimental setup, trajectory guidance reduced the duration of surgery and radiation exposure. Furthermore, it reduced the perforation rate. Accuracy was not improved by the new technique. For clinical cases, the system was integrated into the accommodated surgical workflow and rated as very helpful by users. CONCLUSION The system helped reduce the misplacement rate and the emission of radiation. The main limitations were that trajectories were not displayed in real time and could only be shown in a single fluoroscopic image. However, the system is simple and can be easily integrated into the surgical workflow.
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Affiliation(s)
- Hendrik Schöll
- Department of Trauma, Hand and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
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